Table 2.

Resident Perspective: How Have Attending Teaching Roles Changed with Duty-Hour Regulations and Suggestions for Improvement

Theme	Sample Quotes	Resident Suggestions for Improvement
Increased clinical role	“Attendings have new responsibilities; more paperwork, note writing, talking with patients and their families, so they are not able to teach as much.”	Proactively relieve residents of clinical tasks: “I need an attending to offer help, and to pay attention to how long we are there and step in when it gets close to the time (24+6) that we are required to leave. Otherwise I will just quietly stay there as long as needed to get the work done and end up violating work hours”
Altered time management	“It's great to have more explicit time limits so that attendings better manage the rounding period”	Demonstrate schedule sensitivity, prepare for rounds: “Being concise is the key. Tangents are not tolerable in our new system” “A great attending paces rounds and avoids digressions and interruptions” “Read about the patients before the start of postcall rounds”
Change in presentations	“There is no time for lengthy rambling presentations. The pressure is on to be brief and focused”	Encourage succinct presentations
No adaptive change	“Frankly, some attendings have changed little in their approach, squeezing resident work-time into impossibly short periods”	Be time sensitive and flexible to patient care and resident work time
Changes in teaching Less teaching time	“There is less teaching time because residents are under the burden of getting their work done to get out on time”	Incorporate focused, patient driven teaching: “Great attendings do not give up teaching just because of work hours restrictions—they find ways to fit it in” “Attendings who can teach and help with work are great attendings—it's a balancing act”
Changes in teaching More focused teaching	“Attendings must be concise teachers and pace themselves on rounds if they wish to protect time for didactics”	Check in with resident and proactively carve out time for teaching
Real-time teaching	“Attendings teach almost exclusively in the moment”	Teach the “pearls” as they arise on rounds
Impact on autonomy	“Attendings are micromanaging more. I feel like my autonomy is decreased” “Attendings who can't readily transition from the active management role to the supervisory role challenge my need to think on my own”	Respect autonomy—keep residents in the loop, guide, not direct patient care: “Attendings should act like the rudder on a ship—let me do the ing and move in a direction, but gently redirect me when the boat moves off course”
No change	“I noticed no change in teaching”	Adapt teaching to the time constraints of duty-hours